Jennifer Chu asked:




The most powerful muscle in the body is the gluteus maximus. We have previously discussed its origin, insertion, nerve supply and its actions. We should now discuss the concept and importance of this muscle in creating chronic myofacial pain especially how it can develop into producing total body pain (fibromyalgia) and chonic fatigue with or without pain.

Low back pain due to L5 and S1 nerve root irritation is very common and starts young. So by the time the patient presents with lower back pain in middle or old-age, even though the pain may be acute due to sudden or insidious trauma, the pain symptoms may progress to develop into a chronic pain stage, many times involving the whole body as in fibromyalgia with accompanying fatigue. This is because the L5 and S1 nerve roots may have had chronic changes for several decades prior to the onset of acute symptoms.

Gluteus maximus comes into play in shortening contractions such as the act of standing up, squatting down, bicycling or swimming as the hip and thigh moves backwards (hip extension), etc. Although these movements strengthen the gluteus maximus, the fact that there are reciprocal movements of hip extension into hip flexion that calls for its lengthening contraction, makes it prone to injury.

Its actions are most important during lengthening contractions to stabilize the hip in flexion such as walking, sitting, lunging forward, maintenance in the squat position, hip flexed position during bicycling etc. predisposes it to injuries.
These frequent lengthening contractions in the presence of L5 and/or S1 nerve root irritation (gluteus maximus has very strong S1 nerve root supply) causes weakness in this most powerful muscle in the body.

Pain and spasm in the gluteus maximus will add more weakness to the underlying nerve related weakness in this muscle due to spinal nerve root irritation. Incoordinated contraction of the gluteus maximus due to pain and spasm can lead to buckling of the hip and knee causing the person to fall causing more injuries to other segments of the spine.
Shortening contractions of the gluteus maximus with very little reciprocal movements into hip flexion can be encouraged by walking backwards. This is an exercise activity that is extremely useful for strengthening the gluteus maximus since it does not call for reciprocal hip flexion.
The most optimal method to have shortening contractions of the gluteus maximus without reciprocal hip flexion movements is the eToims Twitch Relief Method. The twitch contractions produce internal stretch exercise and encourage local blood flow allowing nerves to heal.
The importance of treating gluteus maximus properly relates to the myofascial connection to the midback and neck through the thoracolumbar fascia and to the other lower limb muscles such as the tensor fascia lata through the iliotibial tract.

Muscles supplied by the cervical nerve roots such as the latissimus dorsi and the trapezius muscles are connected to the gluteus maximus through the thoracolumbar fascia.
Concurrently or eventually, patients with lower back problems especially at the L5 and S1 levels will develop neck, midback and lower back pain due to tightness of the thoracolumba fascia.
Often there will be pain down the upper limbs from cervical nerve root irritation and lower limbs from lumbosacral nerve root irritation. This picture of total body pain results in fibromyalgia and fatigue from presence of multiple focal muscle spasms in many muscles supplied by many cervical and lumbosacral nerve roots.

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